Helping patients with early hip arthritis avoid surgery.
In regenerative medicine, there is the philosophy that we can reduce the degeneration and inflammation associated with osteoarthritis and/or heal tendon and ligament injuries. Whilst we have been effectively treating patients with musculoskeletal injuries and disease for years, the research is starting to catch up. Here is a new study I reviewed on platelet-rich plasma (PRP) and early hip arthritis.
Our quality of life is at the utmost importance as we age. A large part of this quality of life is living with no or manageable pain and remaining as active as possible. Traditionally, medicine has treated osteoarthritis with treatments that further destroy the joint. With the development of therapies that promote healing within the joint and associated structures such as PRP and/or Stem Cells, there is now a real opportunity to improve the quality of life of our patients without using treatments that lead to surgery. We now know that one of the most common injections used traditionally to treat osteoarthritis, steroid or cortisone injections, actually cause cartilage loss over time.
Hip arthritis is a very different problem than arthritis of the knee. Hip arthritis can progress very quickly (within 1-2 years) whereas knee arthritis tends to be slowly progressive, taking a longer period of time to worsen. The hip joint is also a very different joint in structure and function compared to the knee joint. At the later stages of hip arthritis, orthobiologic treatments, such as PRP and stem cells can struggle to reduce pain and improve function as the hip joint bones become involved and weaken causing collapse of the hip joint. So being proactive about hip arthritis is crucial to a patients quality of life!
New Research on Hip Arthritis and PRP
Presented recently at the Arthroscopy Association of North America annual meeting, researchers (Kraeutler) compared hyaluronic acid (a lubricating injection for knee osteoarthritis) injections against PRP injections in a randomised control trial. Of the 32 patients who received PRP injections in their hips, only 11% went on to need a total hip replacement, compared to 50% of the 30 patients who received hyaluronic acid injections in their hips (over 6 months). It was also noted that the PRP group had better functional scores and range of motion on follow up.
The take home message is this recent research supports the hypothesis that regenerative medicine treatments can in fact reduce the degeneration and inflammation in arthritic joints, which in turn can reduce the need for total joint replacement surgery. We have been treating hip arthritis for years in the hope that we can buy time for our patients and reduce the need for surgery whilst providing a better quality of life.
Reference: Kraeutler MJ, et al. A double-blind, randomized controlled trial comparing platelet-rich plasma vs. hyaluronic acid for early osteoarthritis of the hip joint. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.